Distributive justice
Distributive justice requires consideration of fairness and the broader population consequences of a choice, in addition to the impact on the individual patient. Although the support needed for the initiation of any inhaler is broadly similar in terms of education and explanation to ensure appropriate technique, there is likely to be some opportunity cost to switching inhalers. It may be sensible to build this into annual reviews rather that attempting to switch a whole population at once. Avoiding the initiation of these products should of course start immediately if the takeover goes ahead.
It’s nearly 70 years since Philip Morris vice president George Weissman announced that if the company had any thought or knowledge that in any way they were selling a product harmful to consumers, they would stop business immediately16. Rather than do this, the tobacco industry have denied the science, aggressively marketed cigarettes to young people and consistently opposed tobacco control measures. The attempt by the industry to present itself as promoting healthcare while simultaneously profiting massively from cigarettes is obscene. Moreover, although the burden of tobacco production falls most heavily in poorer countries, profits accrue in the rich3.
The tobacco industry makes £900 million profit /year on UK sales alone and has a much higher profit margin (50-70%) than other products such as food and household goods (typically 12-20%)13. This represents a substantial market failure, as the industry is only profitable because it is able to avoid paying for the external costs of its products - the global societal costs of tobacco are estimated to be more than $2 Trillion/year17. Rather than engaging in expansion into the healthcare sector, the tobacco industry must instead be forced to pay to put right the harm it has caused. The fact that PMI are in a position to takeover Vectura highlights the need for the government to take forward the proposed polluter pays levy on tobacco industry profits18.